Neonatal mortality in developing countries: an analysis of trends and determinants

There is limited understanding of how both trends and determinants of neonatal mortality vary from post-neonatal mortality, and more specifically how health care variables are associated with deaths in the first month of life. In particular the association between care at delivery and neonatal mortality is difficult to determine: in developing countries many women only seek skilled care once complications arise, making poor outcomes more probable. It is therefore inappropriate to directly compare outcomes from those who did and did not receive care at delivery due to this heterogeneity between the groups.This three-paper PHD thesis attempts to address some of these issues. Chapter 1 provides an overview of what is known about the determinants of neonatal and child mortality, before developing a conceptual framework for the analysis of neonatal and post-neonatal deaths.Chapter 2 (paper 1) provides a comprehensive analysis of the quality of Demographic & Household Surveys (DHS) data, before describing how trends in neonatal mortality differ from post-neonatal mortality over the short- and medium- term. It then examines how the associations between gross domestic product and neonatal, post-neonatal and early childhood mortality at national level differ using both cross-sectional and longitudinal data.Chapter 3 (paper 2) uses DHS data from Bangladesh to carry out bivariate and multivariate analysis to determine how the determinants of neonatal mortality vary from those of postneonatal mortality. It also tries to identify groups of women who are at ‘high’ or ‘low’ risk from institutional deliveries and compares rates of neonatal mortality. The risk categories are based on socio-economic, maternal health and health care utilisation factors that influence whether or not they are likely to have planned their delivery care or sought hospital care only in the event of complications.Chapter 4 (paper 3) furthers this work using Indian DHS data by examining how the association between health care determinants and neonatal mortality differ by asset quintile, mother’s education and state-level access to professional attendant at delivery. In this chapter I also use instrumental variable methodology to overcome the problem of endogeneity between delivery care variables and neonatal mortality. This technique enables me to examine the association between professional assistance at delivery while adjusting for the heterogeneity between women who do and do not seek such care. Chapter 5 concludes with a summary of key findings, as well as outlining areas for further research in this area

Investigation of Consumer Freezing Practices, Condition and Duration on Palatability of Beef

The objective of these studies was to determine: the impact of extended periods of frozen storage duration and packaging type on palatability traits of cooked beef steaks from two muscles and the impact of freezing type and storage duration on objective and subjective measures of ground beef palatability traits. In study 1, no differences were elicited from any of the possible interactions (P= 0.95) for SSF or CL: package × muscle × freezing duration, package × muscle, package × duration or muscle × duration. However, freezing duration did impact both SSF (P \u3c 0.01) and CL (P \u3c 0.001). Generally, for both SSF and CL steaks that were frozen for 9-months elicited both the highest SSF values as well as the greatest percentage of CL among all treatments. In comparison, EM was impacted by the interaction (P = 0.059) of packaging type muscle freezing duration. Samples from OW GM stored for 9-months elicited the highest percentage of EM while fresh OW LL samples resulted in the lowest. Additionally, expressible moisture was impacted by the interaction (P = 0.047) of muscle freezing duration. Among all treatments, GM steaks that were frozen for 9-months elicited the highest EM values and fresh LL samples the lowest EM values. Contrastingly, there was no significant difference observed in expressible moisture for the interaction (P 0.18) of package type freezing duration or for the interaction (P = 0.70) of package type muscle. Generally, fresh OW GM steaks resulted in the greatest concentration of lipid derived volatile compounds such as aldehydes, hydrocarbons and alcohols which contrasted sensory ratings of trained panelists that indicated oxidized and refrigerator-stale ratings increased as storage time increased for OW steaks. In study 2, The interaction of freezer treatment × storage duration impacted gumminess (P = 0.05), a TPA attribute. In greater detail, samples stored in RF for 6-months resulted in the greatest gumminess values (P \u3c 0.001), while those stored in the CF for 12-months elicited the lowest (P \u3c 0.001). Similarly, flavor development was also impacted by the interaction (P = 0.05) of freezer treatment × storage duration. Three lipid derived compounds were of greatest concentration among RF patties stored for 1-month. In contrast, the interaction of freezer treatment × storage duration elicited no impact on consumer ratings, SF or TBARS. Nonetheless, frozen storage duration impacted TPA, flavor development, consumer ratings, SF and TBARS as a main effect (P \u3c 0.05), especially in regard to tenderness and juiciness. Moreover, beef flavor development, tenderness and juiciness are impacted by freezing duration, muscle, freezer type and packaging, however these factors are not necessarily independent of one another. Furthermore, the retail display period is a critical period for fresh beef steaks, especially when packaged in aerobic conditions. For optimal eating experience, beef products should be stored for extended periods in a vacuum packaging, in a designated freezer that is not opened frequently to allow for optimal air flow regulation and minimize freezer burn to improve tenderness and juiciness

Investigation of Consumer Freezing Practices, Condition and Duration on Palatability of Beef

The objective of these studies was to determine: the impact of extended periods of frozen storage duration and packaging type on palatability traits of cooked beef steaks from two muscles and the impact of freezing type and storage duration on objective and subjective measures of ground beef palatability traits. In study 1, no differences were elicited from any of the possible interactions (P= 0.95) for SSF or CL: package × muscle × freezing duration, package × muscle, package × duration or muscle × duration. However, freezing duration did impact both SSF (P \u3c 0.01) and CL (P \u3c 0.001). Generally, for both SSF and CL steaks that were frozen for 9-months elicited both the highest SSF values as well as the greatest percentage of CL among all treatments. In comparison, EM was impacted by the interaction (P = 0.059) of packaging type muscle freezing duration. Samples from OW GM stored for 9-months elicited the highest percentage of EM while fresh OW LL samples resulted in the lowest. Additionally, expressible moisture was impacted by the interaction (P = 0.047) of muscle freezing duration. Among all treatments, GM steaks that were frozen for 9-months elicited the highest EM values and fresh LL samples the lowest EM values. Contrastingly, there was no significant difference observed in expressible moisture for the interaction (P 0.18) of package type freezing duration or for the interaction (P = 0.70) of package type muscle. Generally, fresh OW GM steaks resulted in the greatest concentration of lipid derived volatile compounds such as aldehydes, hydrocarbons and alcohols which contrasted sensory ratings of trained panelists that indicated oxidized and refrigerator-stale ratings increased as storage time increased for OW steaks. In study 2, The interaction of freezer treatment × storage duration impacted gumminess (P = 0.05), a TPA attribute. In greater detail, samples stored in RF for 6-months resulted in the greatest gumminess values (P \u3c 0.001), while those stored in the CF for 12-months elicited the lowest (P \u3c 0.001). Similarly, flavor development was also impacted by the interaction (P = 0.05) of freezer treatment × storage duration. Three lipid derived compounds were of greatest concentration among RF patties stored for 1-month. In contrast, the interaction of freezer treatment × storage duration elicited no impact on consumer ratings, SF or TBARS. Nonetheless, frozen storage duration impacted TPA, flavor development, consumer ratings, SF and TBARS as a main effect (P \u3c 0.05), especially in regard to tenderness and juiciness. Moreover, beef flavor development, tenderness and juiciness are impacted by freezing duration, muscle, freezer type and packaging, however these factors are not necessarily independent of one another. Furthermore, the retail display period is a critical period for fresh beef steaks, especially when packaged in aerobic conditions. For optimal eating experience, beef products should be stored for extended periods in a vacuum packaging, in a designated freezer that is not opened frequently to allow for optimal air flow regulation and minimize freezer burn to improve tenderness and juiciness

LINKING HEALTH BEHAVIOR THEORY AND INTERVENTIONS TO INCREASE HUMAN PAPILLOMAVIRUS VACCINE UPTAKE

Human papillomavirus (HPV) is the most common sexually transmitted disease in adults in the United States (US). Persistent HPV infection can cause several cancers, including cervical, oropharyngeal, and anal cancer. To prevent these cancers, the U.S. Advisory Committee on Immunization Practices recommends that all adolescents start the HPV vaccine series at ages 11-12 years. Despite the safety and efficacy of available HPV vaccines, vaccine uptake rates remain lower than public health goals. In the US, only 51.1% of eligible adolescents have completed the vaccine series, a rate lower than the Healthy People 2020 goal of 80% coverage for series completion. In Montana, only 53% of females and 43.9% of males have completed the series. Suboptimal HPV vaccine uptake rates and existent disparities must be addressed to decrease HPV-attributable cancer risk. This paper describes which interventions may be effective in increasing HPV vaccination rates in Montana through a review of the literature on HPV vaccination interventions and their use of health behavior theories, and an analysis of local parent and adolescent feedback about HPV vaccination. The literature review focused on education interventions, provider communication interventions, and health systems interventions to increase HPV vaccine uptake. I found that the use of health behavior theories to inform HPV vaccination interventions was inconsistently reported in published studies of interventions; however, several health behavior theories did support the potential for effectiveness of certain interventions. For example, stage behavior theories may provide tools to move a parent from hesitancy to willingness to vaccinate. The behavior theory constructs of subjective norms and cues to action support provider recommendation and reminder/recall interventions. Most HPV vaccination interventions that I identified were conducted in urban populations, which limits their generalizability to rural populations like those in Montana. However, local parents emphasized the importance of reminders to complete the HPV vaccine series. Provider recommendations were also highly valued. This literature review and analysis of local parent and adolescent feedback provides valuable information for stakeholders seeking to increase HPV vaccine uptake in adolescents

Reconsiderations: After The Idea of a Writing Center

Originally published in a 1984 issue of College English, Stephen North\u27s article The Idea of a Writing Center has over the years been much cited in writing center scholarship. Even so, this scholarship as a whole did not proceed to gain much presence in CE and other broadly-oriented composition journals. Reconsidering North\u27s piece, the authors argue for greater attention now to writing centers as sites for potentially valuable scholarly inquiry. (Contains 8 notes.